There is an ongoing debate surrounding the American Board of Internal Medicine’s (ABIM) board certification and recertification programs, particularly regarding costs and overall value. Central to this discussion is a critical question; does passing the initial certification exam translate into better clinical outcomes? And, does maintaining certification through recertification play a meaningful role in improving patient care? These questions hold significant weight, especially as they impact hospital privileges and insurance credentialing.
Answering these questions requires ongoing, evidence-based research. A recent study by Gray et al. in the Journal of the American Medical Association, , has significantly advanced this ongoing research. The study, focused on Hospitalists and their initial board-qualifying examination. The results found that the certification examination score, but not the residency milestones ratings, was associated with improved outcomes in the population studied. These improved outcomes included 7-day mortality and readmission rates. Interestingly, the study also found that residency milestone ratings were not linked to these outcomes. These findings emphasize the importance of certification exams and highlight the need for further investigation in this area.
Maintaining competency is not only important, it’s essential to delivering high-quality care. In a field where treatments and technology progress rapidly, and as artificial intelligence becomes more integrated into our standards of care, we must begin to test the competencies of our clinicians in the use of such algorithms. Conducting research to answer the question of the value of maintenance certification brings significant value to those governing boards of health systems as they grapple with their responsibilities of ensuring high-quality care. Because medical staff are the ultimate purveyors of privileging, there can be inherent biases in whether to give privileges. Criteria may be too stringent, which reduces clinician competition, or too loose, causing the increased likelihood of patient harm. These governing bodies must be equipped with the knowledge and understanding of these dynamics to deliver on their charge.
We must continue to ask these important questions and support the necessary research needed to answer them. By understanding the value that certification and continuous improvement offers in helping us make more informed decisions about patient care, we are better equipped to address our responsibilities to those we serve. This understanding should also reassure us that the conflict caused when a clinician feels their trade is restricted, is a necessary part of our commitment to personal care. Our primary mission is high-quality care, and we must strive to make sure those we deem able to deliver it are genuinely able to do so.